Many young women wonder when they should first see a gynecologist, and women of all ages often aren’t sure how often to visit a sexual or reproductive health practitioner. The answer depends on a variety of factors, including the woman’s age, health profile, and level of sexual activity. In general, a woman should visit her gynecologist once a year, unless circumstances make additional visits necessary.

The First Visit

Most family planning advocacy groups advise that a woman make her first appointment when she becomes sexually active. The age at which this happens differs in countries all over the world, but generally falls between the ages of 15 and 21. Young women who plan to become sexually active should visit a gynecologist or their family doctor or nurse practitioner first to discuss birth control options and safe practices. Most healthcare professionals suggest that sexually active women in good health, who are not pregnant, get yearly check-ups.

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If a woman has not engaged in any sexual behavior, including oral sex or any kind of intercourse, it’s suggested that she see a gynecologist for the first time when she is 21 years old. Whether or not sexual activity has occurred, the first visit will typically include a pelvic examination and a confidential medical history. Medical professionals usually recommend that a woman have a Pap test for cervical abnormalities within three years of becoming sexually active, but this test is not always performed during the first visit to a gynecologist.

Reproductive Years

The American College of Obstetrics and Gynecology (ACOB) and other sexual health organizations generally suggest that women have yearly exams, with Pap tests every three years. An exception is that the ACOB advises that a woman over 30 years old who has had at least three normal Pap tests need only have a gynecological checkup every two to three years, unless she has a Pap test with abnormal results. On the other hand, a woman who has more than one sexual partner, or whose partner is active with others, might require the typical annual visit.

Many women think of gynecological visits as solely for sexual and reproductive health, but this exam is important for other reasons too. In addition to a pelvic exam, the annual visit typically includes a breast exam and a thyroid check, as a means of screening for lumps that might be cancerous. These checks are equally as important as the pelvic exam for women of all ages.

Aside from the scheduled annual visit, healthcare professionals recommend that a woman visit her gynecologist if she has questions or problems at any other time. For example, if she has any problems or concerns with birth control, menstruation, unexplained pelvic or breast pain, or notices a lump in her breast, she should schedule an appointment as soon as possible. This is true even if she has recently had her annual exam.

Pregnancy

If a woman becomes pregnant, she might need to see her gynecologist or obstetrician on a much more frequent basis. As a pregnancy progresses, visits can become more frequent, perhaps even bi-weekly or weekly. This is often a matter of personal preference; not everyone will feel the need for frequent visits, but sometimes it is medically necessary. For example, if the woman or her fetus need monitoring for health reasons, frequent appointments might be required early in the pregnancy.

Some medical professionals recommend a pre-conception visit for a woman who is planning to become pregnant, particularly if there are any congenital diseases, such as spina bifida, in the family. The first few weeks are a crucial time for fetal development, so preparing physically can be a good step towards a healthy pregnancy. In addition, a gynecological visit is a typical first step for a woman who is having trouble conceiving.

During and After Menopause

A common misconception among women is that the need for gynecological visits decreases during or after menopause, but in fact the opposite is true. The risk of certain diseases, including breast cancer, cardiovascular disease, and high blood pressure, increases with age, and it gets even higher after menopause for women. The ACOB advises that sexually active women continue to have annual gynecological visits until the age of 70.

Discuss this Article

anon149327Post 3

Actually following on from my post, "no country has reported a decline in the incidence of or the mortality from cervical cancer in women under 30, irrespective of cervical screening. Many countries do not perform cervical screening on women under 30"...taken from "Cervical cancer screening" pull-out feature (for doctors!) in the "Australian Doctor" 2006 by Assoc Prof Margaret Davy, Director, Gyn-oncology, Royal Adelaide Hospital and Dr Shorne, GP.

Women under 30 don't benefit from pap tests, but expose themselves to high risk from false positives which can mean awful fear and worry after an "abnormal" result until you're re-tested 6 or 12 months later or referral for colposcopy and potentially harmful biopsies or other "treatment" like LEEP or cone

biopsies. These biopsies especially the last 2 can leave you with health problems - cervical stenosis (that may require surgery and can cause infections, infertility, the need for c-sections or endometriosis) or cervical incompetence (miscarriages, high risk pregnancy that may require cervical cerclage), premature babies.

These are serious problems - minimize these risks by making an informed decision about screening and if you want it, consider the Finnish and Dutch program - 5 yearly from 30, 5 to 7 tests in total. Don't let doctors over-screen you - the risks go way up! --Elizabeth

You might want to do some research yourself with this advice - I totally disagree with it.

You might like to know that Australian and UK doctors don't recommend well woman exams at all in symptom-free women, at any age. I'm in my early 50's and have never had one, it has never been suggested to me and I'd refuse it anyway. These exams are at the top end of invasive and should only be done when absolutely necessary.

I believe these exams are responsible for lots of other unnecessary and potentially harmful biopsies, treatments, other diagnostic tests even surgery. You have the highest rates of hysterectomy in the world. A massive one in three of you will have one by

age 60, and you have very high rates of benign cervical and breast biopsies. (false positives)

These exams expose you to risk for no/negligible benefit. The pap test is the only exam recommended here and of course, it's an optional cancer screening test. All cancer screening has risk and it's benefits are usually confined to a very small number of women. Your risk profile becomes important - as a low risk woman it was an easy decision for me - in Australia the lifetime risk of cervix cancer is 0.65 percent, one third (at least) of women who get this cancer have had a normal test result or series of them - false negatives - these women are therefore not helped by the test and may be disadvantaged by being falsely reassured and receiving a later diagnosis. A tiny 0.45 percent benefit from testing, but almost 78 percent are referred after an abnormal pap - almost all are false positives.

In the States it's higher - 95 percent of you will be referred to help 0.65 percent.

Never allow over-testing or inappropriate testing. Women not yet sexually active are excluded from testing. Women in lifetime mutually monogamous relationships might also choose not to test. (you can't catch HPV from another virgin). Women who've had full hysterectomies for benign conditions don't need testing. The elderly and very young need to closely consider the benefits and risks - testing women past age 50 or 60 is of negligible benefit and carries risk.

Also, testing does not change the tiny death rate from cervical cancer in women under 25. (but they produce very high false positive rates - one in three - while it's one in 14 in older women) As a result, Finland and the Netherlands don't test before age 30 and then only five yearly to age 60 and the UK tests three yearly from age 25 and five yearly from age 50-65.

Look at the risk factors for this cancer, your risk profile and make an informed decision. If you want to test, don't allow over-screening. Five yearly from age 30 is enough for any woman. Even the prostitutes in the Red Light District in the Netherlands only have five yearly testing from age 30. Any more and they simply face false positives and unnecessary biopsies and harmful over-treatment.

Using condoms regularly in partners of unknown status reduces the risk of HPV by as much as 70 percent -- a huge reduction in a very small risk.

I see a doctor when I have symptoms or if I need medical advice and I couldn't be healthier. I think it must be a miserable life spending your life in stirrups - they are never used in consult situations here either. (only during day procedure and in surgery).

You should ask yourselves whether this "examine everything every year" of your life is really in your best interests or is it just doctors looking at turning healthy women into lifelong income-generating machines? Many women will end up harmed by these exams. Your health warrants the time it will take to do some research.

Dr. Joel Sherman's medical privacy forum under women's privacy issues has some great references in the side bar. See amazing research by Angela Raffle, UK screening expert also, Richard DeMay, US pathologist and Prof Michael Baum, UK breast surgeon.

I have also declined mammograms due to concerns about over-diagnosis and false positives. See: "The risks and benefits of mammograms" at the Nordic Cochrane Institute's website.

The American practice of coercing women into these exams before prescribing the Pill is unethical and a violation of your legal rights. Any doctor who refuses the Pill until you submit to gyno exams should be challenged and reported. The only thing required for the Pill is a blood pressure test and your medical history.

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